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How AHRQ's Research Helps People

The Fiscal Year 2001 Budget Request continues and strengthens AHRQ's commitment to ensure that the knowledge gained through health care research is translated into measurable improvements in the American health care system. An important part of AHRQ's research is developing knowledge regarding what interventions and processes are most effective in health care. The work of research is not completed with the publication of findings in a major research journal. The results of research must be placed in the hands of those who can put it to practical use in order to produce high quality health care. The following examples demonstrate how AHRQ's research is being translated into practice and highlights the kind of research that will be enhanced at the Fiscal Year 2001 Request level.

Reducing Errors in Health Care

AHRQ-funded research on medical errors and their causes provided the foundation for much of a recent Institute of Medicine report that highlighted the importance of improving health care delivery processes to minimize errors and enhance patient safety, not blaming those who make mistakes.

AHRQ research on the causes of errors has been accompanied by research to develop strategies to prevent errors. An AHRQ-funded research project at LDS Hospital in Salt Lake City, for example, tested a computer-assisted management program to reduce adverse events, excess drug dosages, and other drug-related problems. According to officials at the LDS Hospital, the program proved so effective at improving patient outcomes and reducing costs that eight other hospitals have requested that it be installed at their facilities.

Another study, at Wishard Memorial Hospital in Indianapolis, tested the effect of a computerized system for informing physicians of past test results. The program successfully reduced unnecessary test ordering, led to a 10 percent reduction in patient length of stay, and lowered the cost of hospital care by nearly $600 per patient for those in the study. The study intervention has since been expanded to the entire hospital and its outpatient clinics.

Services for Rehabilitation Patients

Medicare spends over $4 billion annually for the care of roughly 315,000 Medicare patients treated each year in rehabilitation hospitals and units. Researchers funded by AHRQ developed a tool (Function Related Groups, or FRGs) to categorize patients according to their functioning and the complexity of their rehabilitation needs. This tool can distinguish accurately between patients who need more complex and long-term services from those whose rehabilitation is likely to require less time.

In spring 1999, the Medicare Payment Advisory Commission recommended that a modified version of FRGs be
adopted as the basis of Medicare payments to rehabilitation hospitals, because it can promote efficiency
without giving hospitals an incentive to avoid or undertreat patients with complex needs. HCFA has indicated
that it intends to adopt this recommendation.

In addition, the Uniform Data System for Medical Rehabilitation (UDSMR) has incorporated FRGs into its data systems. Some 1,400 medical rehabilitation providers in the United States and other countries use this data system for continuous quality improvement, outcomes management, research, and other purposes.

Better Diagnosis for People with Heart Attack Symptoms

Three-fourths of the 7 million Americans who come to the hospital with symptoms of possible heart attack turn out not to have one. Nonetheless, many of these people are admitted to the hospital because emergency room physicians are unable to know for certain that no heart attack has occurred. New results from an AHRQ-sponsored clinical trial show that the use of a special imaging test on people who have a normal electrocardiograph (EKG) reading, but with symptoms consistent with a heart attack, can reduce by up to 20 percent the number of such people who must spend time in the hospital unnecessarily. If the data from this trial were applied nationally, saving from preventing unnecessary admissions could be $85 million per year.

Put Prevention Into Practice

AHRQ's Put Prevention Into Practice (PPIP) program is designed to translate evidence-based recommendations about appropriate preventive care from the U.S. Preventive Services Task Force into materials that help patients and providers achieve high quality preventive care. The program involves developing and disseminating a variety of tools, ranging from a practical guide for clinicians on how to implement a better preventive services program (Clinician's Handbook of Preventive Services) to materials that patients can use to understand and keep track of the preventive services they receive. In 1999 alone, AHRQ and its program partners distributed more than 3,400 copies of the Clinician's Handbook and more than 110,000 English and Spanish-language Personal Health Guides. A new resource for older adults, Staying Healthy at 50+, was released in January 2000.

The program has become an especially important tool for States seeking to improve the quality of health care for their populations. The Texas Department of Health, for example, has now been using the PPIP program for 5 years and continues to expand its efforts. The State had developed a number of companion tools to use in the program, trained clinical prevention specialists to implement and consult with others on using the program, and sponsored an evaluation of the program in the State.

Other States interested in implementing this program are now looking to Texas. The conference for practitioners, for example, drew several out-of-State attendees, and public health officials in other States have contacted Texas officials to gain from their experiences in implementing the program.

Quality of Cataract Surgery

Each year more than 1.2 million Medicare beneficiaries undergo cataract surgery, the most common Medicare hospital outpatient surgical procedure. A group of AHRQ-sponsored researchers, as part of a broader study of the outcomes of this procedure, developed the VF-14, a tool for assessing the level of visual functioning for people with cataracts. Like FRGs, the VF-14 has become incorporated into a wide variety of efforts to improve the quality of care for people with cataracts and other eye conditions.

HealthPartners, a nonprofit HMO in Minneapolis-St. Paul that serves some 250,000 patients, administers the VF-14 preoperatively and postoperatively to every patient undergoing cataract surgery, both to assess patients' progress and to keep a check on the quality of care they provide by comparing results with national averages.

"We need tools such as the VF-14 to keep a check on the quality of care we provide."

CONQUEST Performance Measures and HCUP Quality Indicators

AHRQ's quality tools have provided the private sector with concrete ways to judge its own performance and improve quality. CONQUEST, a software tool, was developed by AHRQ to give purchasers and providers easy access to a compilation of existing health care performance measures. Along with HEDIS measures, CONQUEST has been used by groups such as the Rochester Health Commission in New York as a basis for establishing quality measures to improve health care in the community. More recently, the Commission began using AHRQ's HCUP Quality Indicators, as well. This tool provides information and benchmarks from hospital inpatient data on conditions and procedures that, when they occur frequently, may indicate possible quality problems.

CAHPS®, a survey-based tool to evaluate peoples' experiences with their health plans, provides yet another way purchasers and others can access information to improve quality. More than 90 million Americans choosing health care plans now have access to CAHPS®-based information on how other consumers rate the plans in their areas. In 1999, Medicare beneficiaries and Federal employees and retirees were among those who can view CAHPS® results for plans in their areas. CAHPS® also continues to be used to provide information to Medicaid beneficiaries and employees in over 20 States and among 10 employer groups and numerous individual employers. For these purchasers, CAHPS® has become a standard and ongoing component of purchasers' efforts to improve care for their enrollees.

Members of the Central Florida Health Care Coalition (CFHCC), a 128-member nonprofit business health care group, have been using CAHPS® for 3 years to improve the quality of the health care plans that serve their employees. After CAHPS® surveys are completed and the results are analyzed, CFHCC members focus on areas with low scores in patient satisfaction. With both the member and the health plan participating in the discussion with CFHCC officials, a strategy for correcting problems can be successfully created and implemented. The goals are to improve ease of access, quality of care, and patient satisfaction.

Using Research to Improve Federal Health Programs

Through the Department's QuIC (Quality Interagency Coordination) Task Force, AHRQ research on diabetes care is contributing to quality improvement government-wide. As one of its initiatives, QuIC
member agencies are using a uniform set of diabetes measures, some of which are based on research on diabetes outcomes produced by AHRQ's Diabetes Patient Outcomes Research Team.

A "Patient Pointer" guide developed by the Memphis Veterans Administration Medical Center, outlining the pros and cons of prostate-specific antigen (PSA) testing for prostate cancer, is based on the findings of AHRQ research on the outcomes of prostate disease.

AHRQ research provides data that Federal agencies use to make estimates of health care use and expenditures for many diverse purposes. Data from AHRQ's Medical Expenditure Panel Survey (MEPS)
are used by agencies ranging from the Congressional Budget Office and the Council of Economic Advisors to the Health Care Financing Administration and the Department of the Treasury. AHRQ analyses (based
on MEPS data) of the number of children potentially eligible for public insurance programs, but not enrolled, have catalyzed Federal efforts to encourage more effective State outreach to uninsured, low-income families with children.

Translating Research for State and Local Policymakers

AHRQ research and dissemination activities help State and local policymakers gain access to relevant evidence and information, as they make the myriad decisions needed to improve the quality of their health care programs. For example:

A North Carolina health official used material from an AHRQ State user workshop in its patient appeals process.

A medical director in Arkansas used information from a workshop as the basis for proposing improvements to her State's process for making technology assessment decisions.

Health officials in Mississippi used workshop materials to initiate joint activities with the insurance commissioner's office in their State to explore ways to assess the quality of care of health maintenance organizations (HMOs) operating in the State.

A Florida health administrator shared workshop information with his staff to help them plan improvements for measuring the quality of care provided in that State's Medicaid program.

In California, a legislator used information from a workshop to design a set of performance plan criteria for health demonstration programs supported by the State.

New Jersey health officials used the research presented in an AHRQ workshop to analyze options and design a better program for hospital charity care.

"I will use the information with my staff as we plan to improve the way we measure the quality of services delivered by Medicaid fee-for-service and managed care providers."